Prostate Cancer Screening: Today And The Future

When evaluating someone with Lower Urinary Tract Symptoms (LUTS), the doctor will use the International Prostate Symptom Score (IPSS) along with a physical examination (including a digital rectal exam or DRE). In addition, a number of tests will be undertaken, such as a urine test called a urinalysis. Depending on the clinical situation, some other tests may be requested in consultation between the patient and the doctor.

These Include:

  • Prostate specific antigen (PSA) – a blood test to screen/ exclude prostate cancer
  • Urinary cytology – a urine test to screen/exclude for bladder cancer
  • A measurement of post-void residual volume (PVR) – the amount of urine left in the bladder after urinating
  • Uroflowmetry, or urine flow study – a measure of how fast urine flows when you urinate
  • Cystoscopy – a direct look in the urethra and/or bladder using a small flexible scope
  • Urodynamic pressure-flow study that tests the pressures inside the bladder during urination
  • Ultrasound of the kidney or the prostate

The Studies Determine the Diagnosis, Which May Be:

  • Urinary tract infection (UTI) – typically treatable with a course of antibiotics
  • Benign Prostatic Hyperplasia (BPH)
  • Chronic prostatitis
  • Bladder
  • Urinary stone
  • Neurological diseases such as Multiple Sclerosis (MS), spinal cord injury and disease.

International Prostate Symptom Score (IPSS)

The IPSS is an eight-question, (7 symptom and 1 quality of life) questionnaire used to derive a score (0-35) and determine the management of Benign Prostatic Hyperplasia (BPH), which is the most common prostate problem. There are various treatment options for BPH, which can be explored with the Urologists that provides them.

Typically, a score of 0-7 indicates mild symptoms, 8-19 moderate symptoms and 20-35 severe symptoms. Higher scores indicate more severe symptoms. Regardless of your score, if the symptoms are bothersome, you should consult with your doctor.

What If Your Prostate Specific Antigen (PSA) is Raised?

PSA is an enzyme found in a man’s blood produced exclusively by prostate cells. Its function is to make semen become more liquid. PSA is produced exclusively by epithelial prostatic cells, both benign and malignant.

  • The amount of PSA in your blood is measured in nanograms of PSA per millilitre of blood (ng/ml).
  • If you are aged 50 to 59, a PSA lower than 2ng/ml is normal higher is abnormal.
  • If you are aged 60-69, a PSA lower than 3ng/ml is normal; higher is abnormal.

A raised PSA level in your blood may be a sign of prostate cancer, but it can also be a sign of another condition that is not cancer, such as:

  • Enlarged prostate or BPH, discussed above.
  • Prostatitis.
  • Urinary infection

PSA Accuracy

About 15 out of every 100 men with a normal PSA level have prostate cancer. About 75 out of every 100 men with a raised PSA level do not have prostate cancer.

Pros and Cons of the PSA Test

You have the right to a PSA test if you are over the age of 50 and are aware of the pros and cons that come with having the test.

Pros

  • It may reassure you if the test result is normal.
  • It can find early signs of cancer, meaning you can get treated early PSA testing may reduce your risk of dying if you do have cancer.
  • If you have a family history of Prostate Cancer, this particularly means if your father or a brother has had Prostate Cancer, your chances of also getting Prostate Cancer are higher than if no one in your family has had it and it is very advisable to be tested.
  • If you are of black ethnic origin or are overweight or obese: these have increased risk factors for Prostate Cancer.
  • More information can be found in the Genetics and Prostate cancer page.

Cons

  • It can miss cancer and provide false reassurance.
  • It may lead to unnecessary worry and medical tests when there’s no cancer.
  • It cannot tell the difference between slow-growing and fast-growing cancers.
  • It may make you worry by finding a slow-growing cancer that may never cause any problems.

Digital Rectal Examination (DRE)

Doctors use the digital rectal exam (DRE) as a relatively simple test to check the prostate. Because the prostate is an internal organ, your doctor cannot look at it directly. But because the prostate lies in front of the rectum, he or she can feel it by inserting a gloved, lubricated finger into the rectum. It may be performed in the screening of prostate cancer.

Not all medical institutions agree on when men should begin screening (routine testing) for prostate cancer or even if a DRE should be part of the screening. To help detect prostate cancer in its early stages, it is recommended that men talk to their doctors about the benefits, risks, and limitations of prostate cancer screening before deciding whether to be tested.

What Happens During a Digital Rectal Exam?

The doctor will insert a gloved finger into the rectum and feel the prostate for hard, lumpy, or abnormal areas. The test takes only a few minutes to complete. You may feel slight, momentary discomfort during the test. The procedure does not cause significant pain or any damage to the prostate.

What Happens After the Digital Rectal Exam?

You may go on with your normal activities. Your doctor will discuss the test results with you. If he or she detects a suspicious lump or area during the exam, further testing will be the next step.

The Future of Testing

Advances in technology, especially the understanding of genomics, proteomics, DNA microarrays, and bioinformatics have led to high expectations about the future of prostate cancer detection, diagnosis, non-invasive therapy, and surveillance after treatment.

Magnetic Resonance Imaging (MRI)

In specific with regard to prostate cancer, some recent studies have indicated that the use of a mpMRI (Multiparametric Magnetic Resonance Imaging) prior to biopsy is able to pick up prostate cancer at an early stage. Nowhere else in modern medicine are the errors of over-diagnosis, over-treatment, missed-diagnoses and poor risk-stratification more extreme. A new study called RE-IMAGINE being run jointly by Imperial College London and University College London will be looking at its accuracy in diagnosing prostate cancer.

The Re-IMAGINE Consortium has been created to undertake discovery that will correct these four key errors. The project will combine the underlying molecular changes in the cancer with state-of-the-art imaging. This will allow the prediction of prostate cancer status for the individual (low, medium or high risk) without recourse to biopsy. It will also allow prediction of which prostate cancers are likely to progress over time and which are not, this has largely eluded scientist so far. By doing so, men will be subject to fewer but better biopsies, improved risk stratification, appropriate treatment allocation, more benefit, less harm and more cost-effective care.

New Blood Tests

When you combine mpMRI with a new blood test being developed by Queen Mary University London, there may not be a need for biopsies at all. The new blood test looks for Circulating Tumour Cells (CTCs). These are cells that have left prostate cancer tumours and have entered the bloodstream. Potentially this new test could help diagnose not only if prostate cancer is present but also how aggressive it is.

However, it is important to remember that CTCs were not detected in some men demonstrating that is may not be suitable for all men. This research is also in its early stages and has only been used on one hundred men. More research on bigger populations will be needed to truly validate whether this test is a useful tool or not.

The Future of Treatment 

Cancer treatment has come a long way in the past 50 years. Procedures are more precise and less damaging. However, there are 2 different types of treatment that we as a prostate cancer charity wholeheartedly support; Cryotherapy and HIFU (Hyper Intensity Focal Ultrasound).

Cryotherapy

Cryotherapy is a treatment that uses extremely cold temperatures to freeze and destroy cancerous cells. In general, it is also known as cryoablation or cryosurgery, but there actually are two types.

  • Whole-prostate cryotherapy treats the entire prostate, including both the cancerous cells together with the surrounding healthy prostate tissue.
  • Focal cryotherapy only treats the part of the prostate that is affected by cancer. It uses fewer needles, which means that less healthy tissue is frozen than in whole-prostate cryotherapy.

It’s important to note that focal cryotherapy isn’t suitable for all men. It all depends on the size of the cancer together with where it is located in the prostate.

What Is Involved When Receiving Cryotherapy 

Cryotherapy is typically carried out while under a general anaesthetic, so patients won’t feel anything during the procedure. However, if patients are unable to have a general anaesthetic, then they might be offered an epidural. During the first stage of the procedure, a tube is passed through the penis and into the bladder, which is known as a warming catheter. Throughout the procedure, warm liquid is passed through the tube so that the urethra and rectum wall doesn’t freeze. The surgeon will then place an ultrasound probe into the rectum to take images of the prostate.

Once the ultrasound probe is in place, and the surgeon is happy with the projected images, thin needles will be placed through the perineum and into the prostate. Freezing gases are then passed through the needles at a temperature of about -40oC, which freezes and destroys prostate tissue. The prostate is then allowed to warm up naturally. The process of freezing and warming is typically carried out twice. Most patients can return home on the same or following day.

HIFU (High Intensity Focused Ultrasound)

In recent years, HIFU has provided a less invasive treatment option which has been shown to reduce the side effects that are typically associated with conventional prostate cancer treatments. It eradicates cancer in the prostate with fewer complications with a process known as Focal Ablation. It generates a pinpoint of heat that is then targeted at cancerous cells around the prostate by focusing ultrasound waves. This type of treatment minimises damage to the nerves that surround the prostate gland, which can preserve sexual function in addition to avoidance of damage to the apical sphincter in order to preserve unitary continence.

How Does HIFU Work? 

The simplest way to explain how HIFU works is to visualise how a magnifying glass focuses light rays from the sun. There’s a transducer that focuses soundwaves, creates heat and destroys tissue at the point to which its aimed at. A typical HIFU procedure lasts between 1 and half hours, depending on the size of the prostate. And, is either carried out under general anaesthesia or an epidural. During the procedure, a catheter is placed through the penis and will stay in place for roughly 1 – 3 weeks. Following HIFU treatment, patients will stay in hospital for 2 – 4 hours for what is known as the recovery period. Once released from hospital, patients can leave to further recover in the comfort of their own home.

Why Prost8 UK Is Campaigning 

At Prost8 UK, we strongly believe in promoting less invasive treatment options for men with early-stage prostate cancer, including Focal Ablation. The most common version of Focal Ablation is HIFU which uses sound waves to create a point of heat, which destroys the cancerous cells with minimal damage to surrounding healthy tissue. We also campaign for earlier awareness of the symptoms of prostate cancer through newer, simpler and more accurate screening. If you would like to support our cause and help us help all men in the UK, then please make a donation today.

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